Strengthening Community Health for FQHCs Through Technology

When the Office of Science and Technology posted its Request for Information (RFI) on strengthening community health through technology, we knew we had to respond. Here is a copy of our full response to the RFI.

Related: Head here for more reading on the value-based care landscape that community health centers are in.

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We would like to thank the Office of Science and Technology Policy for this opportunity to comment on the critical question of how to strengthen community health through technology.  

Federally qualified health centers (FQHCs) and other community health centers (CHC) are essential for improving outcomes and reducing overall healthcare spending, especially among historically underserved populations, including individuals on Medicaid, the uninsured, and the underinsured. Yet these organizations often operate without enough staff, financial support, and technology to meet the entirety of need in their catchment areas.

Yuvo Health helps FQHCs solve these challenges by providing administrative and managed care contracting services, empowering them to unlock new revenue streams and better serve their patients via value-based care. We believe that by eliminating daunting investment and operating burdens, FQHCs will be able to focus on what they do best: providing quality care to communities in need.

Technology is extremely important for proactive clinical decision-making, eliminating administrative obstacles, improving access, and strengthening the patient-provider relationship.  However, we cannot rely on technology alone. We must also use policy levers and emerging reimbursement strategies to create an environment where FQHCs have the skills, resources, and bandwidth to successfully adopt and leverage health IT tools for the greater good.

Barriers to technology adoption for FQHCs and their patients

Many safety net providers simply do not have the funding or expertise to purchase technologies and implement data-driven care pathways for their patients. And many disenfranchised patients in both urban and rural areas lack access to reliable broadband internet to support engagement with virtual health technologies.

Even when tools are available, these technologies are often not designed to meet the needs of FQHCs or their patients. For example, many digital health solutions were not built with historically disenfranchised communities in mind, particularly those with lower rates of health literacy or limited English proficiency. Studies have shown that English as a second language (ESL) speakers use telehealth at only one-third the rate of native English speakers, despite significant levels of interest in utilizing remote care technologies. This suggests that many digital solutions may not be marketed or designed with non-English speakers in mind.

We must make sure that emerging technologies reduce disparities instead of widening them. To improve equity and access, FQHCs and other community-based organizations should be more involved in promoting digital technologies and educating patients about the value of these tools.  

Without sustainable reimbursement streams to support purchasing and implementation, such as those available through value-based care, FQHCs may lack the ability to fully engage their traditionally disadvantaged patients in the same way as other providers can work with their populations.

Lessons learned from the pandemic

During the COVID-19 pandemic, telehealth emerged as a powerful vehicle for increasing access to care when in-person visits were not an option, particularly for individuals in medically underserved areas (MUAs). Remote care also provided an additional, critical revenue source for providers who experienced drastic drops in traditional service volume.

Expanding telehealth parity in response to the public health emergency (PHE) catalyzed the use of remote care across the nation and fueled widespread recognition of the value in continuing telehealth use for primary care, specialty consults, behavioral healthcare, and other services even after the pandemic is over, especially among disenfranchised groups.

We believe that FQHCs and regulators can both build upon these lessons to expand access to care in MUAs and develop stronger, long-lasting relationships with less health literate and more transient populations, as FQHC patients often are.  

If payers and regulators can make telehealth a more permanent and financially viable part of the healthcare toolkit, FQHCs will have additional high-value options for meeting the needs of their varied patient populations.

Proposed government actions to fortify FQCHs and improve digital health equity

Federal regulators have a promising opportunity to foster the adoption of technology within FQHCs.

In our experience working directly with FQHCs, the need for reliable, sustainable reimbursement is always top of mind. FQHCs need more than grant opportunities or pilot program participation.  They need innovative reimbursement options that are tied directly to patient engagement and/or increased utilization of digital health strategies.

These value-based care models should employ a mixture of “carrots and sticks” to ensure participants meet applicable quality measures so that digital health strategies are able to advance in a measured, strategic manner.

More specifically, we would be pleased to see an update to the Medicaid Telehealth Toolkit for a post-COVID-19 world and/or a State Medicaid Director Letter or State Health Official Letter that outlines state reimbursement methodologies for telehealth.

We would also like to see telehealth incorporated more deeply into managed care rates (rate adjustments, in-lieu of services, value added services, etc.) to financially support FQHCs and other community health entities serving these populations.

Thank you for the opportunity to provide perspective on this important matter. We are encouraged by your office’s attention to community health and look forward to working with you further to create a sustainable, resilient, equitable health system for all individuals.